Provider Demographics
NPI:1376538884
Name:TIMMERMAN, CLIFTON N (OD)
Entity Type:Individual
Prefix:DR
First Name:CLIFTON
Middle Name:N
Last Name:TIMMERMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 N 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUCHULA
Mailing Address - State:FL
Mailing Address - Zip Code:33873-2002
Mailing Address - Country:US
Mailing Address - Phone:863-773-3322
Mailing Address - Fax:863-773-6458
Practice Address - Street 1:735 N 6TH AVE
Practice Address - Street 2:
Practice Address - City:WAUCHULA
Practice Address - State:FL
Practice Address - Zip Code:33873-2002
Practice Address - Country:US
Practice Address - Phone:863-773-3322
Practice Address - Fax:863-773-6458
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1317152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078175401Medicaid
FLP00085223OtherRAILROAD MEDICARE
FL19485OtherBLUE CROSS BLUE SHIELD
FL6499700001Medicare NSC
FL078175401Medicaid
FLT84086Medicare UPIN